A generally healthy and independent 83-year-old man presented with long-standing, mild to moderate glaucoma. He had uneventful cataract surgery several years earlier. He also had previous selective laser trabeculoplasty (SLT) with only slight reduction in his intraocular pressure (IOP). His untreated IOP was middle to upper twenties. His recent IOP has been running in the middle to upper teens while using 4 medications in each eye brimonidine, dorzolamide, latanoprost, and netarsudil. His general health is good, and he is not taking any anticoagulants. He reports no trouble administering eyedrops, 1 drop or 2 drops each day, but finds his current eyedrop schedule unmanageable, and his eyes are always red.He was essentially emmetropic, but he had been considerably myopic before his cataract surgery; his axial length is 27.31 mm in the right eye and 27.18 in the left eye (). Sequential visual fields are shown in . His nerve fiber layer optical coherence tomography image is shown in . His angles are wide open in each eye and his IOL is well positioned with a clear and intact posterior capsule. His conjunctiva and sclera are moderately injected but healthy and without scarring.(Figure is included in full-text article.)(Figure is included in full-text article.)(Figure is included in full-text article.)He was referred for surgical intervention to reduce the complexity of his eyedrops regimen and improve the condition of his ocular surface. He does not want a repeat SLT procedure because it "did not work the first time."Which stand-alone glaucoma procedure would you recommend for each eye?This review was conducted to assess the current literature on virtual reality (VR) simulation in cataract surgery training. Studies evaluating the construct and predictive validity of VR simulators, such as the EyeSi simulator, were compiled and compared. Two databases, PubMed and Scopus, were systematically searched, and 20 articles were determined to meet the study inclusion criteria (full-length articles written in English). Of these, 11 studies examined construct validity, and 9 studies examined predictive validity. Although the construct validity of some VR simulators is yet to be established by multiple studies, many of the modules within the EyeSi simulator have been repeatedly validated. Furthermore, several studies have shown that VR simulator training improves overall cataract surgery performance. This review demonstrated the ability of cataract surgery VR simulators to differentiate surgical experience levels and improve operating room performance, which supports the use of VR simulators in ophthalmology residency training.Purpose To assess the effectiveness of intracameral phenylephrine-ketorolac during cataract surgery compared with postoperative topical steroids in reducing the incidence of postoperative clinical cystoid macular edema (CME) confirmed via optical coherence tomography (OCT), breakthrough iritis, pain, and photophobia. Setting Ambulatory surgical center/clinical practice. Design Retrospective 2-cohort study. Methods This study of cataract surgery patients compared the incidence of postoperative CME, breakthrough iritis, pain, and photophobia between patients receiving either intracameral phenylephrine 1.0%-ketorolac 0.3% during surgery or topical loteprednol 0.5% 2 days preoperatively, tapered postoperatively. Patients with prior CME or at high risk for postoperative CME, combined cataract/glaucoma surgery, and medication protocols different from those studied here were excluded. All eyes received bromfenac 2 days preoperatively and 10 weeks postoperatively. Results The study enrolled 2218 eyes (n = 1402). The ioperative topical steroids and NSAIDs.Purpose To report the incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors after cataract surgery using the bag-in-the-lens (BIL) intraocular lens (IOL) implantation technique. Setting Department of Ophthalmology, Antwerp University Hospital, Belgium. Design Prospective cohort study. Methods All consecutive BIL IOL surgeries performed between January 2001 and December 2010 were included, with the exclusion of combined procedures and IOL exchanges. The incidence of RRD was reported first in the total cohort, then in a subgroup of patients with 1 year to 5 years of follow-up, and finally in the group remaining after exclusion of all risk factors, except gender. https://www.selleckchem.com/products/arry-382.html Risk factors associated with RRD were examined using multiple Cox regression analysis with a random intercept. Results Rhegmatogenous RD was diagnosed in 36 eyes (1.06%) of 3385 BIL cases, with a mean follow-up of 48.28 ± 40.05 months (range 0 to 195 months). The 2-year cumulative RRD incidence rate was 0.66% (17 cases in 1024 eyes; 0.00% in patients without risk factors). The 5-year cumulative RRD incidence rate was 1.17% (26 cases in 931 eyes; 0.15% without risk factors). Five risk factors were confirmed male sex, age less than 60 years at the time of surgery, axial length 25.0 mm or greater, a history of contralateral RD, and intraoperative surgical complications. Conclusions The incidence of RRD after BIL IOL implantation is comparable with that of lens-in-the-bag (LIB) implantation. This larger study provided a longer follow-up and suggested that RRD incidence is even lower than that previously reported. This study also confirmed intraoperative surgical complications as an additional risk factor for RRD development, as already described with LIB implantation.Objectives Although recent health care reform efforts have focused on minimizing high cost health care utilization, the relationship between acute care use and health care expenditures among certain vulnerable populations such as Medicaid-insured children remains poorly understood. We sought to evaluate the association between acute care utilization and health care expenditures and to identify characteristics associated with high spending. Methods We performed a retrospective cohort study of Medicaid-enrolled children 1-21 years old from 1/1/2016 to 12/31/2016. Children were categorized by acute care use (including emergency department and urgent care visits) as 0, 1, 2, 3, and 4 or more visits. Our main outcomes were annualized spending, total per-member-per-year spending, and acute care-related per-member-per-year spending. Results There were 5.1 million Medicaid-enrolled children that comprised the study cohort, accounting for US $32.6 billion in total spending. Children with 4 or more acute care visits were more likely to be younger than 2 years or older than 14 years, female, and have a chronic condition.